Scaphoid Fractures - carpal bone fracture

The scaphoid bone is important for both motion and stability in the wrist joint.
Scaphoid fractures are classified into:
Non-displaced and displaced fracture.
acute fractures: less than 3 weeks.
delayed union: from 4 to 6 months.
nonunion: more than 6 months.
distal third or distal pole fractures.
central third or waist fractures.
and proximal third or proximal pole fractures.
The interesting thing about the scaphoid bone is that it has a retrograde blood supply.
This means that the blood flow comes from a small vessel that enters the most distant part of the bone
and flows back through the bone to give nutrition to the cells of the bone.
minor blood supply from branches of volar radial artery,
enters distal tubercle and supplies distal 20% of scaphoid.
Whereas, 80% of scaphoid receives its blood supply dorsally through branches of the radial artery.
a scaphoid fracture can sever this blood flow and stop the delivery of necessary oxygen and nutrients to the bone cells.
When this occurs,
healing can be slow,
and it may not heal at all.
Scaphoid fractures usually cause pain and swelling in the anatomic snuffbox and on the thumb side of the wrist.
The pain may be severe when you move your thumb or wrist,
or when you try to pinch or grasp something.
With some fractures, the pain is not severe and may be mistaken for a wrist sprain.
With most fractures, there will be tenderness directly over the scaphoid in the anatomic snuffbox dorsally.
and scaphoid tubercle tenderness volarly.
scaphoid compression test:
the test is positive when pain reproduced with axial load applied through thumb metacarpal.
Your doctor will order an x-ray to help determine if you have a scaphoid fracture
and whether the broken pieces of bone are displaced.
An x-ray will also help your doctor determine if you have any other fractures.
The scaphoid view is a posteroanterior picture taken with the wrist in full pronation and ulnar deviation.
This view shows the scaphoid in its longitudinal axis without superimposed shadows from the distal radius.
In lateral radiographs, the scapholunate angle should fall between 30 and 60 degrees.
This angle is formed by a line bisecting the scaphoid in its longitudinal axis and another line bisecting the lunate.
In some cases, a scaphoid fracture does not show up on an x-ray right away.
If your doctor suspects that you have a fracture but it is not visible on x-ray,
he may recommend that you wear a wrist splint or cast for 2 to 3 weeks and then return for a follow-up x-ray.
Non-displaced fractures of the distal scaphoid can be treated in a short-arm thumb spica cast,
typically for 6 to 10 weeks.
Non-displaced fractures at the waist or proximal third of the scaphoid can be treated in a long-arm thumb spica cast for six weeks,
followed by a short-arm cast until healing is documented.
Your doctor will monitor your healing with periodic x-rays every 2 weeks.
your doctor may recommend the use of a bone stimulator to assist in fracture healing.
All fractures that are displaced more than 1 mm should be referred for surgery.
Comminuted fractures.
Proximal pole fractures.
Delayed treatment more than 4 weeks.
Fractures associated with peri-lunate dislocation.
scapholunate angle more than 60 degrees.
and if the patient is unwilling or unable to wear a cast for long period of time in non-displaced waist and proximal third fractures
and he desires for faster return to work and sport.
the surgical treatment is internal fixation with special screws or Kirschner wires.
percutaneously , or by open surgery.
In some cases, a bone graft may be used with or without internal fixation.
After surgery, you will usually be in a cast for eight to 12 weeks.
the healing is monitored with periodic x-rays every 2 weeks.
you have to avoid smoking which can delay or prevent fracture healing.
Whether your treatment is surgical or nonsurgical,
you’ll likely need physiotherapy for two or three months after the cast is removed
to regain strength and mobility in your wrist and muscles around it.
Nonunion.
a scaphoid fracture can sever this blood flow and stop the delivery of necessary oxygen and nutrients to the bone cells,
increasing the risk of nonunion,
particularly with fractures at the waist and proximal end.
If the scaphoid fracture does not heal within 6 months,
your doctor may consider surgery to insert a bone graft.
he may use a special kind of graft with its own blood supply called vascularized bone graft.
Osteonecrosis.
When the blood supply to the bone is disrupted by the fracture,
the bone cells will die.
This condition is called "avascular necrosis."
A vascularized bone graft is the most effective treatment for this condition,
providing the bone has not collapsed significantly
or arthritis has not developed in the wrist.
Osteoarthritis.
Over time, nonunion and avascular necrosis of the scaphoid can lead to osteoarthritis of the wrist.
#scaphoid #scaphoidfracture #brokenwrist #wristfracture #wrist

[@nimsherpa6236]

This video got all the information needed. Thanks a bunch

[@reginawade7370]

My fracture did show up on x ray first day. In a splint now.

[@silent6282]

Scaphoid bone fracture no surgery healing time plz? Now 2 months cast only

[@fatimaskitchen-fk786]

Aslam Alekum sir how much i can lift the weight with scaphoid fractured bone after removing of cast of 2 years ????

[@drtarekorthoclinic]

As pain tolerated

[@fatimaskitchen-fk786]

@@drtarekorthoclinic shukriya...

[@fariidtv7127]

@@drtarekorthoclinicmy wrist injury happened about 18 years ago. Can I still get it treated